scalp folliculitis

[beegeelady]

I have suffered for almost 5 yers with pimples on scalp, The scalp gets very sore in a circular pattern , bumps come up or pimples with blood, pus and serum. My dermatoligist said it was a folliculitis and put me on minicin which helped 100% but then I became allergic to it. She tried Doxycyclene and it did nothing. Multiple antibiotics were tried. Some cleared it up for about 3-4 weeks and then it comes back. Some did not help at all. I have been on Bactrim DS 800-160 tab for a year. I take two per day for 7 days and it clears up for about 4 weeks and returns. My regular Doctor thinks it is Seborrea and has put me on Clobex shampoo, which makes it worse, tar shampoo which does nothing, several other prescription shampoos to no avail and cortisteroid lotions etc. None seem to have any effect. My dermatologist thinks it is a deep infection of unknown cause, cannot be cured and has no other solutions. My regular doctor has put me on Ampicillen during bad break outs but it did not help much, ceprofloxacin which did help, Levofloxacin which cleared it up completely for about 6 weeks. Many others which did not always work but some did for short spans. My scalp gets so sore I cannot lay on it. I wash my hair at least every other day because of the drainage. I continue to take the Bactrim but would like to know what you think. At times I just cannot think straight with this condition which seems to go on forever. Please give me any advice.


This discussion is related to Overuse of Clobetsol.

[Vanessa Lacuesta]

Hi,

Differentials for this will be a bacterial infection ( furuncle or carbuncle), a fungal infection
( tinea capitis), and discoid lupus erythematosus.

Furuncle is a common condition affecting the skin follicles. "Furuncles are generally caused by Staphylococcus aureus, but they may be caused by other bacteria or fungi. They may begin as a tender, red nodule but ultimately feel like a water-filled balloon. A furuncle may drain spontaneously, producing pus. More often the patient or someone else opens the furuncle."

Source:http://www.nlm.nih.gov/medlineplus/ency/article/001474.htm

The other differentials mentioned , are associated with hair loss. Tinea capitis may be associated with a scaly plaque with a well defined border. They may be bright red,weeping and swollen. As for the discoid lupus, there is localized patterns of hair loss and the center of the lesions are slightly lighter. The hair loss is sharply localized. Are any of these applicable in your case?

I suggest that a culture of the discharge from the affected skin may be done to ascertain an underlying infectious cause. The culture will help guide treatment as it will determine the appropriate medications that an organism may be sensitive to.

[beegeelady]

Thank you for your response, I do have hair loss when the follicles are infected but it goes away as soon as I start talking the Bactrim. The hair seems to mostly grow back but not 100%. I have had it cultured and it was gram negative. I do not seem to have a scaly plaque or even the usual dandruff associated with seborrea. The hair loss is not localized but just an all over shedding. The swelling and pimples feel like they are large but I cannot see them as they are on the crown and back of my head. Even the ones I get to the side down to the back of my ears are hard for me to get a look at. Both the dermatologist and my regular doctor say they are not big like the faruncle or carbuncle you mention. They are small-just hurt and feel big to me. Sometimes I scratch before I catch myself and this seems to start them draining and then where I have scratched they start to dry and heal and the pain is relieved on that spot. I do n ot pull hairs out as I have read some people do. I try very hard not to disturb them. The dermatologist did put me on the nose cream Bactroban for a possible staph but it did not have any effect.

I have read on other sites that I do not seem to be alone with this condition. Others describe identical symptoms and years of problem with no real help from dermatologists. They seem to have tried tea shampoos, drugs of all kinds and home remedies all to no avail. Their complaint of soreness, pimples and swelling seem to correspond with mine. Lab tests do not seem to give many answers. I realize there is probably not a cure out there but relief and control would be welcome.  Does any of this sound familiar? I will try anything and will definitely get another lab test done.

[Vanessa Lacuesta]

Hi,

There may be an underlying bacterial infection here as the condition does respond to the antibiotics. However, scalp conditions are those that may not be readily treated. Was a fungal infection established?

A microscopic evaluation of skin scrapings using potassium hydroxide may establish a fungal infection which may not respond to antibiotics. A dermatitis may also be present which may all the more delay the healing process.

At this point, several differentials may be given your case, but skin conditions such as this may not be effectively treated especially if an underlying chronic inflammatory cause is present.